Provider Demographics
NPI:1215375407
Name:ENDODONTIC ASSOCIATES
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S., M.S.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-7949
Mailing Address - Street 1:1225 BRECKENRIDGE DR
Mailing Address - Street 2:STE 203
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1558
Mailing Address - Country:US
Mailing Address - Phone:501-227-7949
Mailing Address - Fax:501-227-7763
Practice Address - Street 1:1225 BRECKENRIDGE DR
Practice Address - Street 2:STE 203
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1558
Practice Address - Country:US
Practice Address - Phone:501-227-7949
Practice Address - Fax:501-227-7763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty